Individual health coverage · Ohio · 2026
Health coverage options in Ohio —
ACA plans, Health Shares, DPC, and more.
Ohio uses the federal HealthCare.gov exchange for ACA enrollment. The 2026 benchmark premium for a 40-year-old is $513/month. Ohio has expanded Medicaid, which means residents below 138% FPL ($22,590/yr for a single adult) may qualify for state Medicaid. This page covers what each coverage type costs in Ohio, who qualifies for subsidies, and where the real trade-offs are.
−20%
Ohio ACA enrollment drop in 2026 — second largest among the 7 launch states
ACA plans in Ohio
What ACA plans cost in Ohio in 2026
Ohio uses the federal exchange at HealthCare.gov — there is no state-run marketplace. For 2026, multiple insurers participate in the Ohio marketplace through the federal HealthCare.gov exchange. Check healthcare.gov for current carrier availability in your county.
The 2026 benchmark silver premium for a 40-year-old in Ohio is $513/month. For households below the 400% FPL subsidy cliff ($62,600 for a single adult), subsidies can significantly reduce this cost. Above the cliff, you pay the full amount.
| Annual income | % of FPL (single) | Full benchmark | Estimated subsidy | Your est. monthly cost |
|---|---|---|---|---|
| $20,000 | 128% FPL | $513/mo | ~$628/mo | ~$33/mo |
| $30,000 | 192% FPL | $513/mo | ~$511/mo | ~$150/mo |
| $40,000 | 256% FPL | $513/mo | ~$395/mo | ~$266/mo |
| $50,000 | 320% FPL | $513/mo | ~$286/mo | ~$375/mo |
| $62,600 | 400% FPL | $513/mo | ~$141/mo | ~$520/mo |
| $63,000+ | Above cliff | $513/mo | $0 | $513/mo |
Estimates for a single adult, age 40. Subsidy calculated using IRS Rev. Proc. 2025-25 applicable percentage table and 2025 HHS poverty guidelines. Actual subsidy depends on exact income, household size, and county. Source: KFF.org · IRS Rev. Proc. 2025-25. Use the comparison tool for your specific ZIP, age, and income.
Ohio has expanded Medicaid
Ohio has expanded Medicaid. Adults earning up to 138% FPL ($22,590/yr for a single adult) may qualify for Ohio Medicaid. If your income is below 138% FPL, check eligibility before purchasing any marketplace or alternative coverage. ACA marketplace subsidies are available for incomes between 138% and 400% FPL. Use the comparison tool to estimate your subsidy.
Ohio ACA marketplace — key 2026 facts
Ohio enrolls through HealthCare.gov only — no state exchange. 16 insurers for 2026 (Aetna exited; Harbor Health joined). HMO and EPO plans only — no PPO available on-exchange. Open enrollment: November 1 – January 15. Coverage begins January 1 for plans selected by December 15, February 1 for plans selected December 16–January 15. Source: healthinsurance.org Ohio marketplace.
2026 Ohio benchmark — key numbers
Benchmark premium — age 40, Ohio
$513/mo
Premium increase vs 2025
Near national avg
Subsidy cliff — single adult
$62,600/yr
No-subsidy-zone below 100% FPL
$15,650/yr
Medicaid expanded — residents up to 138% FPL ($19,937/yr single adult) may qualify. Source: KFF.org 2026
Subsidy cliff — Ohio
A single adult earning $62,500 receives a subsidy — at $63,000 the subsidy drops to $0 and the full $513/mo applies. This sharp cliff is why residents above the threshold explore Health Shares and other alternatives. Use the comparison tool to see your numbers.
Alternatives to ACA plans in Ohio
How Health Shares, DPC, and STM compare in Ohio
| Coverage type | Typical monthly cost | What it covers | Key limitation | Enrollment |
|---|---|---|---|---|
| ACA plan (unsubsidized) | $513/mo (age 40) | Full ACA coverage — pre-existing, mental health, maternity | No PPO on-exchange · HMO/EPO only · high deductibles | Nov 1–Jan 15 |
| Health Share | $150–$350/mo est. | Major medical after Annual Unshared Amount | Not insurance · pre-existing often excluded · voluntary sharing | Year-round |
| DPC + Health Share | $230–$480/mo est. | Unlimited primary care (DPC) + major medical (Health Share) | Pre-existing often excluded · not regulated as insurance | Year-round |
| Direct primary care only | ~$92/mo avg | Unlimited primary care — no major medical | Must pair with other coverage for hospitalizations | Year-round |
| Short-term medical | $95–$165/mo est. | Major medical for temporary gap — 3–4 month terms | Pre-existing excluded · not MEC · terms limited | Year-round |
Why the Health Share + DPC combination is relevant in Ohio
Ohio has a significant self-employed population in Columbus, Cleveland, Cincinnati, and across the state. For Ohioans above the subsidy cliff, the $513 benchmark is lower than most Southern states, but still represents over $6,100/year unsubsidized. For Ohio residents above the 400% FPL subsidy cliff earning above $62,600/year, the gap between what unsubsidized ACA costs ($513/mo) and what a Health Share + DPC combination costs ($230–$480/mo) makes alternatives worth evaluating seriously. The combination does not replace ACA coverage for people with pre-existing conditions or subsidy eligibility — but for healthy residents above the cliff, it is a financially compelling option.
Short-term medical in Ohio
Yes. Short-term medical insurance is available in Ohio. Ohio law (Bulletin 2018-05) defines STM plans as policies lasting no more than 364 days. Ohio STM plans do not technically renew, but a new policy can be purchased after the previous one expires. Ohio also requires STM plans to cover certain services including mammograms, autism spectrum disorder treatment, and newborn care. After the August 2025 federal enforcement suspension, some insurers resumed offering policies up to 364 days. As of early 2026, at least 7 insurers offer STM in Ohio. STM does not count as ACA minimum essential coverage. Source: healthinsurance.org Ohio STM tracker.
Initial term allowed
up to 364 days (non-renewable)
Maximum total duration
up to 364 days per policy — new policy can be purchased after expiry
ACA marketplace — 2026 carrier & plan guide
Ohio marketplace carriers, plans, and pricing
The table below shows every carrier offering ACA marketplace plans in Ohio for 2026, what metal tiers they offer, their network type, and estimated starting premium for a 40-year-old before subsidy. Availability varies by county — verify at healthcare.gov for your specific ZIP code.
Carriers — 2025
13
marketplace insurers
Carriers — 2026
11
▼ 2 fewer than 2025
National average
9.0
insurers per state 2026
2026 notable changes: Aetna and HAP CareSource exited. 11 carriers — most of our 9 states. Cigna ⚠ and CareSource ⚠ announced exit after 2026. Source: KFF — Insurer Participation 2026.
Premiums are estimates for a 40-year-old non-smoker before any subsidy. ⚠ carriers are participating in 2026 but have announced exit after the 2026 plan year — 2027 coverage will need to be selected from remaining carriers. Carrier count and county availability vary. Always verify at healthcare.gov for your ZIP code.
See your exact costs for Ohio — enter your income and ZIP
The comparison tool calculates your ACA subsidy, benchmark premium, and how alternatives compare — for your specific age, income, and Texas ZIP code.
Ohio health coverage — common questions
Individual health coverage in Ohio — questions people ask most
Does Ohio have its own health insurance marketplace?
No. Ohio uses the federal exchange at HealthCare.gov — there is no state-run marketplace. Texas is one of the largest states to rely entirely on the federal exchange. The Texas Department of Insurance regulates carrier rates and network adequacy, but enrollment runs through CMS-operated HealthCare.gov. 16 insurers participate in the Texas marketplace for 2026, offering HMO and EPO plans only — no PPO plans are available on-exchange.
What is the 2026 ACA benchmark premium in Ohio?
The 2026 benchmark silver premium for a 40-year-old in Ohio is $513/month. Premiums are age-rated: younger adults pay less, older adults pay more. For a 60-year-old, the benchmark premium is significantly higher. If your household income is between $15,650 and $62,600 (100%–400% FPL for a single adult), you likely qualify for a premium tax credit that reduces this cost. Use the comparison tool to calculate your specific subsidy. Source: KFF.org 2026.
Does Ohio have Medicaid expansion?
Yes. Ohio has expanded Medicaid. Ohio has expanded Medicaid. Adults earning up to 138% FPL ($22,590/yr for a single adult) may qualify for Ohio Medicaid. If your income is below 138% FPL, check eligibility before purchasing any marketplace or alternative coverage.
Are Health Shares available in Ohio?
Yes. Health Shares are available to Ohio residents year-round with no open enrollment requirement. Health Shares are not insurance and are not regulated by the state Department of Insurance — they operate under contract law and are subject to the state Attorney General’s oversight. Pre-existing conditions are typically excluded or subject to waiting periods. See the Health Shares guide for a full explanation.
What are the best health coverage options for self-employed Ohio residents?
It depends on your income. If your projected MAGI is between $15,650 and $62,600 (single adult, 2026), an ACA plan with a subsidy is almost always the most cost-effective option. If your income exceeds $62,600, you face the full $513/month benchmark premium with no assistance. At that income level, a Health Share paired with a DPC membership is a common alternative — total monthly cost typically $230–$480/month. Note that self-employed residents can deduct health insurance premiums — ACA premiums and Health Share contributions have different tax treatment. Consult a CPA for your specific situation.
Is short-term health insurance available in Ohio?
Ohio law (Bulletin 2018-05) defines STM as policies lasting no more than 364 days — Ohio plans do not technically renew, but a new policy can be purchased after expiry. Ohio also requires STM plans to cover mammograms, autism spectrum disorder treatment, and newborn care. Following the August 2025 federal enforcement suspension, some carriers resumed offering policies up to 364 days. At least 7 insurers offer STM in Ohio. STM does not satisfy ACA minimum essential coverage and losing it does not trigger an ACA SEP. See the short-term medical guide.